What have you touched today?

By Elisabeth Stepan-Rivard, Ines Sousa and Victoria Blanchard

The Issue

High prevalence of illnesses among university is an important issue, which can result in absenteeism and deadline extensions. With a total of roughly 25 000 students at the University of Warwick, there is no doubt that the spread of illnesses, such as the infamous ‘fresher’s flu’ can occur at a rapid pace. Accordingly, previous research demonstrated that 91% of university students had upper-respiratory tract illnesses (URIs) such as colds and influenza-like illnesses (ILI), within the 6-month period. URIs have been previously associated with morbidity in university students (Nichol, Heilly & Ehlinger, 2005). As a result, within the 6 month period, URIs caused around 45 219 days of illness among the 4919 university students (Nichol, Heilly & Ehlinger, 2005). Reductions in general health have been associated with URIs, emphasising the effects of illnesses on overall well-being (Nichol, Heilly & Ehlinger, 2005), therefore, neccessary  measures should be introduced to reduce URIs.

Additionally, White and colleagues (2005) showed that, based on weekly data regarding washing behaviour, sanitizer use and illness, the experimental group - who were exposed to a health campaign and given free hand gels - had significantly better hand hygiene than the control group. This reflects a difference in both hand-washing behaviour and hand sanitizer use. Compared to the control group, the experimental group also reported 26% less illnesses. Based on pre/post reports of knowledge, attitudes and perceived behaviour, results also show that knowledge about hand hygiene as well as positive attitudes towards gel sanitizers increased in the experimental group but not in the control group.

Several studies have also  indicated a connection between hand sanitization and infection control in numerous settings such as extended care facilities, schools, and hospitals. Hand-hygiene practices were improved with increased frequency of hand washing through increasing awareness of the importance of hand hygiene, and the use of alcohol gel hand sanitizer in university dormitories. This caused a reduction in URIs, illness rates and absenteeism (White et al., 2003). Specific figures included a total average improvement  of 20% in upper respiratory-illness symptoms (White et al., 2003). Additionally, those with better hand hygiene had 43% less missed school/work days (White et al., 2003).

What we’ve done - The solution

We began by brainstorming our ideas about the topic. We asked ourselves key questions such as ‘Does the university successfully promote hygiene?’ ‘Are there hand sanitizer dispensers around campus?’. It quickly became apparent that there was room for significant improvement. Being university students ourselves, we are familiar with the inconveniences of being ill e.g. extending deadlines, missing lectures etc. As a group, we were eager to promote the issue of hygiene via leaflets/posters, but also to incentivise students to actually clean their hands more e.g. by receiving free hand sanitizers. Free samples are usually very popular amongst consumers - especially students - leading to increased interest towards the product. We knew funding would be a vital component of our campaign, and so we decided to contact the SU for financial aid.

The SU Education Policy Manager was our first point of contact. It was with him where the initial proposal of ideas were presented. He then instructed us to fill out the SU Funding Application form, which we completed and sent off on the 10th February. On the 16th February we received an invitation to formally present our proposal at the SU in front of a panel of 7 staff members. Important details of the proposed project were discussed, such as the driving motives, pricing, location etc. This presentation was vital for our project in justifying why the SU should support us. On the 21st February we were delighted to receive a confirmation of the motion, stating the SU’s willingness to fully fund the purchasing of 216 hand gels, costing a total of £153!

To further extend our project, we applied the foot-in-the-door technique - making a small request and following it up with a bigger request (Cialdini, 2007) - in order to try and  make hand hygiene a permanent Policy at the University on the 22nd February. Suggestions such as permanent hand sanitizer dispensers across campus were proposed. We will find out the outcome at the end of term 3 and hope the University will start acknowledging the importance of hygiene on campus.

Promptly after this request, we ordered the hand gels online via Amazon. We also individually designed informative hand hygiene leaflets, which would also be distributed alongside the gels. We had 7 different designs, each with differing persuasive approaches. Upon arrival of the hand gels, we were ready to start handing them out to the students. We chose to distribute the hand gels next to the entrance of the library, during lunch time. This was an appropriate location, as many many students walk through there, and the peak lunch hour meant students were more likely to use the product right before eating their meals. Each hand gel was given together with one informative leaflet. Questions regarding hygiene were also personally asked to every student. This gave us an indication of how students felt towards our campaign and hand hygiene in general. During the distribution of gels, we all posted on social media platforms such as Instagram and Snapchat, to spread awareness of our event. Indeed, many students purposely came to the library just to receive the hand gels, due to seeing the event on social media.

Techniques used

1.  Priming                              

Priming is a well-known phenomenon. It is the process by which exposure to certain cues (e.g. words, smells, images, etc.) alters behavior without the person being aware of its influence (Bargh, 1992). For example, on television, snack commercials tend to prime eating behaviours (Harris, Bargh & Brownell 2009) and smaller plates lead to reduced food intake (Wansink & Cheney 2005). Other priming studies show that individuals are more likely to keep their surroundings clean when primed with certain olfactory scents (Holland, Hendriks, & Aarts, 2005) and with cues of being watched - also shown to encourage prosocial behaviors (Nettle, Nott, & Bateson, 2012). Priming can be used to change behaviors relevant to public health (King et al, 2016) and so, in line with research, our aim is to prime students to improve their hygiene through hand gels and leaflets around campus.

2.  Commitment

According to the commitment and consistency rule, people strive to behave consistently with choices they’ve already made (Cialdini, 2007). Using the foot-in-the door technique, which proposes that making a small request that people will say yes to will increase the likelihood of them committing to a bigger request in the future, we firstly asked individuals for a small favour - to use the obtained hand sanitizer product, and then asked them to commit to a larger action - rethink and improve their hygiene behaviour.

Additionally, making a public commitment has been shown to contribute to a more lasting change (Cialdini, 2007). Individuals were asked to make a public verbal commitment to using the hand sanitizer gel. For instance, individuals would be asked: “When are you going to start using this hand sanitizer?” According to the principle of consistency individuals will be encouraged to develop a new image of themselves as a hygiene conscious individual as well as come up with reasons as to why they should wash their hands in order to remain consistent with their new self-image.

3.Fundamental templates

Following research suggesting how to effectively persuade, we used the following templates in our project. Many of the techniques were instrumental in the design of our leaflets that were handed out on campus.

A) Pictorial Analogy

Pictorial analogy works by producing a striking image, taking a familiar item and giving it a twist to show a product benefit or consumer need (Goldenberg, Mazursky, & Solomon, 1999). Through the image of angelic clean hands, we aimed to promote the positive effect of hand gel on overall hygiene.

B) Consequences template

Consequence template describes a strategy for motivating people to take a particular action, follow a certain policy, or purchase a particular product, by arousing fear and presenting individuals with the consequences if the change is not made. Research has consistently identified fear to be effective at changing people’s attitudes and behaviours (Tannenbaum et al., 2015). In the leaflets that individuals were given together with the hand sanitizer individuals were presented with a fear arousal image on a women with and without spots, they were then given information about the consequences of touching their face with dirty hands.

C) Interactive experiment template

An interactive experiment template involves providing individuals with an activity in order for them to engage and interact with the product (Goldenberg, Mazursky, & Solomon, 1999). It is used to encourage exposure and realisation of the benefits of the product. In our case we handed hand sanitizer gels to students, raising the problem of hygiene that can be resolved by using this product. Figure 1. provides an example of one of the leaflets that was handed out around campus. 

Figure 1. An example leaflet.

A study by Lammers (1991) shows the powerful effect free samples can have on behaviour. Figure 2 shows that the free samples given in the study had a significant and positive effect on the instant purchase of the product. More specifically, of those who received a free sample, 84% subsequently purchased something. This is in stark contrast and significantly different to the group who did not get a free sample where only 59% purchased something. A further examination shows that the effect of free samples was stronger in products of small prices (up to five dollars). These findings are of particular relevance to our project, given that the price of individual hand sanitizers only cost around £1. This low price makes the purchase of hand sanitizers more likely.

Figure 2. The effect free samples have on immediate purchases of chocolate

4. Reciprocity

According to the rule of reciprocation, all individuals feel obliged to repay debts of all kinds (Cialdini, 2007). Therefore, in social psychology, receiving a favour, even when not asked for, is associated with an increased likelihood for the person to commit to a request in the future. In our study we used free samples of hand sanitizer gels and asked participants to commit to a request to start using the product as soon as possible. We gave individuals something that is obviously and exclusively for their benefit, naturally activating the process of reciprocity. According to the rule of reciprocation, as a result of receiving a free product, individuals will feel obliged to repay the favour and are likely to do so by complying with the requests  to improve their hygiene.

Behaviour Change Measured

During the campaign, students were asked a number of questions regarding their plans on future hygiene behaviour. Of those students who received a free hand sanitizer sample and an information booklet, only 7% of students reported using hand sanitizer already, whilst others only reporting hearing about hand sanitizer for the first time. However, 86% said they wanted hand sanitizer machines to be installed in the library and toilets around the campus. Similarly, the majority of the students complied to trying the hand sanitizer gel.

Additionally, throughout campaign we received 538 views on social media platforms like Instagram, facebook and snapchat. Uploading information about the campaign online attracted people instantly, with a number of people asking questions about it and leaving positive reviews.

A week after the distribution of the hand sanitizer gels, we interviewed some of the students who participated in the campaign. Of those asked, all reported continuing the use of hand sanitizer and increase in hand washing. We therefore concluded that the priming effect seemed to have worked in this short time frame and hope that the future continuous distribution of gel by the University will keep on priming students to take more care of their hygiene.

References:

Bargh, J. A. (1992). Does subliminality matter to social psychology? Awareness of the stimulus versus awareness of its influence. In R. F. Bornstein & T. S. Pittman (Eds.), Perception without awareness: Cognitive, clinical, and social perspectives(pp. 236-255). New York, NY, US: Guilford Press.

Cialdini, R. B. (2007). Influence: The psychology of persuasion. New York: Collins.

Goldenberg, J., Mazursky, D., & Solomon, S. (1999). The fundamental templates of quality ads. Marketing science, 18, 333-351.

Harris, J. L., Bargh, J. A., & Brownell, K. D. (2009). Priming effects of television food advertising on eating behavior. Health psychology, 28, 404.

Holland, R. W., Hendriks, M., & Aarts, H. (2005). Smells like clean spirit: Nonconscious effects of scent on cognition and behavior. Psychological Science, 16, 689-693.

King, D., Vlaev, I., Everett-Thomas, R., Fitzpatrick, M., Darzi, A., & Birnbach, D. J. (2016). “Priming” hand hygiene compliance in clinical environments. Health Psychology, 35, 96.

Lammers, H. B. (1991). The effect of free samples on immediate consumer purchase. Journal of Consumer Marketing, 8, 31-37

Nettle, D., Nott, K., & Bateson, M. (2012). ‘Cycle thieves, we are watching you’: Impact of a simple signage intervention against bicycle theft. PloS one, 7, 1-4

Nichol, K. L., Heilly, S. D., & Ehlinger, E. (2005). Colds and influenza-like illnesses in university students: impact on health, academic and work performance, and health care use. Clinical Infectious Diseases, 40, 1263-1270.

Tannenbaum, M. B., Hepler, J., Zimmerman, R. S., Saul, L., Jacobs, S., Wilson, K., & Albarracín, D. (2015). Appealing to fear: A meta-analysis of fear appeal effectiveness and theories. Psychological bulletin, 141, 1178.

Wansink, B., & Cheney, M. M. (2005). Super bowls: serving bowl size and food consumption. Jama, 29), 1723-1728.

White, C., Kolble, R., Carlson, R., Lipson, N., Dolan, M., Ali, Y., & Cline, M. (2003). The effect of hand hygiene on illness rate among students in university residence halls. American journal of infection control, 31, 364-370.

White, C., Kolble, R., Carlson, R., & Lipson, N. (2005). The impact of a health campaign on hand hygiene and upper respiratory illness among college students living in residence halls. Journal of American College Health, 53, 175-181.